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Source: Paulette Stevens
The paraphiliac focus of Transvestic Fetishism involves crossdressing. Usually the male with Transvestic Fetishism keeps a collection of female clothes that he intermittently uses to crossdress. While crossdressed, he usually masturbates, imagining himself to be both the male subject and the female object of his sexual fantasy. This disorder has been described only in heterosexual males. Transvestic Fetishism is not diagnosed when crossdressing occurs exclusively during the course of Gender Identity Disorder.
Transvestic phenomena range from occasional solitary wearing of female clothes to extensive involvement in a transvestic subculture. Some males wear a single item of women’s apparel (e.g., underwear or hosiery) under their masculine attire. Other males with Transvestic Fetishism dress entirely as females and wear makeup. The degree to which the crossdressed individual successfully appears to be a female varies, depending on mannerisms, body habitus, and crossdressing skill.
When not crossdressed, the male with Transvestic Fetishism is usually unremarkably masculine. Although his basic preference is heterosexual, he tends to have few sexual partners and may have engaged in occasional homosexual acts. An associated feature may be the presence of Sexual Masochism. The disorder typically begins with crossdressing in childhood or early adolescence. In many cases, the crossdressing is not done in public until adulthood. The initial experience may involve partial or total crossdressing; partial crossdressing often progresses to complete crossdressing.
A favored article of clothing may become erotic in itself and may be used habitually, first in masturbation and later in intercourse. In some individuals, the motivation for crossdressing may change over time, temporarily or permanently, with sexual arousal in response to the crossdressing diminishing or disappearing. In such instances, the crossdressing becomes an antidote to anxiety or depression or contributes to a sense of peace and calm. In other individuals, gender dysphoria may emerge, especially under situational stress with or without symptoms of depression.
For a small number of individuals, the gender dysphoria becomes a fixed part of the clinical picture and is accompanied by the desire to dress and live permanently as a female and to seek hormonal or surgical reassignment. Individuals with Transvestic Fetishism often seek treatment when gender dysphoria emerges. The subtype With Gender Dysphoria is provided to allow the clinician to note the presence of gender dysphoria as part of Transvestic Fetishism.
Specify With Gender Dysphoria if: The person has persistent discomfort with gender role or identity.